MEDICARE: JOSE BRUNO PEREZ CARDOSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1669300091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE BRUNO PEREZ CARDOSO

Provider Business Mailing Address
First Line	:	531 W SAN YSIDRO BLVD APT 25
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-2352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	TORRE CENTURY
Second Line	:
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22000
Country	:	MX
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOSE BRUNO PEREZ CARDOSO
Credential	:	DDS
Telephone Number	:	619-272-9021

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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